Ortho 2 Flashcards
What are the most common C/S of CCLR? what does CCLR stand for?
cranial cruciate ligament rupture
lameness, pain, exercise intolerance, effusion, periarticular fibrosis (medial buttress), crepitation, instability (depending on degree of CCL), meniscal click
what stifle stability tests should you use to test for CCLR and what do you expect the results to be with a….
1) complete tear
2) partial tear
cranial drawer and tibial thrust
1) positive for both
2) flex +, extension - (for drawer)
what is the general underlying cause of CCLR?
what does this mean for typical progression of the disease?
we don’t know
most common causes are trauma (changing direction quickly while all the weight is on that one knee) and chronic joint disease
it’s a degenerative condition –> progressive
what diagnostic steps can be performed for suspected CCLR? explain in basic terms that each of these provide and why they may or may not be valuable to you and your client?
rads: confirm diagnosis, rule out other causes of lameness, sx planning
chem: pharmaceuticals
what are the medical mgmt options for CCLR?
essential!
weight loss!!
exercise modification + formal rehab
pain mgmt (NSAIDs)
what medical mgmt option for CCLR is the MOST important?
weight loss
what are the surgical options for CCLR?
gold standard
must include eval and tx of meniscus
extrascapular techniques:
- simulate CCL outside joint
- depend on development of periarticular fibrosis
- best for dogs <15kg
osteotomies/ostectomies:
- TPLO, TTA, CCW, CBLO
- suitable for all sizes of dog
- primary choice for dogs >15kg
are all surgical options for CCLR equally effective for all dogs?
no
use extra scapular techniques for <15kg and osteotomies/ostectomies for >15kg
what are the common C/S of patellar luxation?
intermittent “skipping” lameness
progressing lameness, chronic
what PE findings do you expect with patellar luxation?
fails sit test, skipping gait, mild effusion in stifle joint, cranial tibial drawer test in flexion but not extension
do CCLR and patellar luxation differ in the degree of expected radiographically apparent osteoarthritis?
what do the legs of dogs with patellar luxation look like? in other words, what are the implications of patellar luxation?
there are 7 abnormalities associated with patellar luxation, but apparently we won’t be asked about them on exam, we just need to know their implications
twist and torsion of tibia outwards flares out distal femur –> because concentration of force is slightly medial to where it should be in a straight line. bones are flaring out to match direction of forces
muscles, patellar, patellar ligament misaligned
bony abnormalities end up happening to accommodate that misalignment due to patella being out of place
what are the grades of patellar luxation?
grade 1 = in, in: patella is in trochlear groove, can be luxated out manually, spontaneously reduces in
grade 2 = in, out: patella in trochlear groove, can luxate out on its own and stays out
grade 3 = out, in: patella out of trochlear groove, can be reduced manually
grade 4 = out, out: patella not in groove, cannot be reduced in - no trochlear ridge
does grade of patellar luxation impact treatment?
yes it does. lower grade means lower severity. dogs with grade 1 can have medical mgmt for years.
what are the main categories of surgical treatment options for patellar luxation?
soft tissue procedures (desmotomy, quadriceps release, partial capsulectomy, reticular overlap) - rarely used alone
groove reconstruction procedures - deepen trochlear groove (sulcoplasty, chondroplasty, wedge recession trochleoplasty, block recession trochleoplasty)
limb alignment procedures - try to straighten limb (fabellotibial anti-rotational suture, tibial tuberosity transposition, distal femoral osteotomy)
